How Does Psychotherapy Begin?

Embarking on a journey of short or, more importantly, long-term psychotherapy necessitates careful consideration of your safety. Several parameters should be discussed “on the shore” before diving into the therapeutic process. Renowned psychologist and consultant Irina Bogoraz emphasizes the importance of addressing questions of psychological ethics in this delicate process.

Unfortunately, in the United States, the field of psychology lacks legislative regulation, sparking ongoing discussions about the need for laws governing psychological services to the public. In the absence of a nationwide legal framework, each branch of psychology develops its own ethical codes, varying in some aspects while sharing similarities in others.

What is the Significance of a Psychotherapy Contract?

Psychotherapy commences with the establishment of a contract between the involved parties. Irina Bogoraz notes, “It doesn’t always have to be a written agreement; it can be verbal. However, in my 9 years of practice, clients often forget the specifics discussed with the therapist during the first meeting due to nervousness. Therefore, I prefer a written contract. It’s not a legal document; it’s merely a visualization of agreements, a future reference. It doesn’t even need to be signed; it can be sent via email.”

Initially, the psychologist assesses the client’s needs and confirms their ability to handle the case—there are instances where therapy may be contraindicated. Subsequently, specific parameters that satisfy both parties are incorporated into a prepared text. This includes session costs, notification procedures for fee changes, session frequency, and consequences for lateness and missed appointments from both the client’s and therapist’s perspectives.

“This depends on the individual psychologist. Some colleagues of mine insist on full payment for missed sessions if the client doesn’t cancel within a day or a few hours,” explains Irina. This is often a necessary measure as not every psychologist has their own office and may incur rent expenses regardless of the client’s circumstances. It’s crucial to inform the client in advance about this point and financial details.”

Effective communication regarding the cost of the initial session and subsequent meetings should occur before the client invests their time and effort. The therapist is obligated to create a safe environment for the client, and the contract, whether oral or written, forms its foundation. Additionally, the psychologist outlines whether note-taking during sessions is permissible.

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If a client consents to the written documentation, audio, or video recordings of sessions, the psychotherapist must securely store them, protecting them from third-party access. Upon the client’s request, the therapist must promptly provide access to these recordings. If a client opposes any form of recording, even in a notebook, the therapist must respect this preference and rely on their memory.

Consultations must transpire in a “safe” space where confidentiality is a paramount guarantee.


How Does Psychotherapy Begin?

Psychotherapy typically starts with the establishment of a contract between the psychologist and the client. This contract, whether verbal or written, outlines the parameters of the therapeutic relationship, including session costs, frequency, and procedures for changes in fees.

Where Can Psychotherapy Contracts Take Place?

Psychotherapy contracts can occur either verbally or in writing. Psychologists often prefer written agreements, as they serve as a visual reference for both parties. The contract is not necessarily a legal document but a tool to clarify and visualize the agreed-upon terms of the therapeutic process.

What Factors Are Considered in Psychotherapy Contracts?

Psychotherapy contracts consider various factors, including the client’s needs, the psychologist’s ability to address those needs, session costs, notification procedures for fee changes, session frequency, and consequences for lateness and missed appointments. Each psychologist may have their own policies.

When Should Psychotherapy Fees Be Discussed?

It is crucial to discuss psychotherapy fees before the client invests time and effort in the therapeutic process. This includes clarifying the cost of the initial session and subsequent meetings. Transparent communication about financial aspects ensures a clear understanding between the client and the therapist.

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How Is Confidentiality Maintained in Psychotherapy?

Confidentiality in psychotherapy is maintained by respecting the client’s privacy. If a client agrees to recorded sessions, the psychotherapist must securely store the recordings. However, if a client opposes any form of recording, the therapist must honor this preference and rely on their memory for session details.

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1 Comment

  1. I prefer a written contract.

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